Unmasking malnutrition

Pakistan - 740,000 child deaths a year and half of them
linked to malnutrition.

Over 8 million of the 13 million under-five deaths in the world each
year can be put down to diarrhoea, pneumonia, malaria, and vaccine-preventable
diseases. But this simple way of classifying hides the
fact that death is not usually an event with one cause but a process
with many causes. In particular, it is the conspiracy between
malnutrition and infection which pulls many children into the downward
spiral of poor growth and early death.

Nonetheless, the fact that it is possible to put dramatic figures on
the disease element in this partnership has helped to focus attention
on problems like measles and diarrhoeal disease - and on the
availability of low-cost methods of preventing or treating them.

Now, a new study has attempted to quantify the role of malnutrition in
child deaths.

Using data from 53 developing countries, researchers from Cornell
University have concluded that over half of those 13 million child
deaths each year are associated with malnutrition. Further, they show
that more than three quarters of all these malnutrition-assisted
deaths are linked not to severe malnutrition but to mild and moderate
forms.

This contradicts the idea that death rates only rise when children are
severely malnourished. By the same token, it suggests that nutrition
programmes focusing only on the severely malnourished will have far
less impact than programmes to improve nutrition among the much larger
number of mildly and moderately malnourished children.

The method used in this calculation was developed from eight
large-scale community studies. Despite very different settings, all of
these studies demonstrated a remarkably consistent relationship
between the risk of death and the child's weight-for-age.

This is the first time that such estimates have been made for so many
countries using epidemiological methods. But confidence in the result
is boosted by the fact that the overall findings conform well to the
conclusions of the one large-scale clinical study that was conducted
more than 20 years ago.

As discussed in the 1994 edition of The Progress of Nations,
low-cost methods of reducing all forms of malnutrition are available
and have been shown to work. And action on both fronts - to improve
nutrition and to protect against disease - could save many more lives
(and be far more cost-effective) than action on either front alone.

The table below shows the role of malnutrition in child
deaths for the 53 countries in which the new method has so far been
applied.